Who Goes First? Influences of Human-AI Workflow on Decision Making in Clinical Imaging

Details of the designs and mechanisms in support of human-AI collaboration must be considered in the real-world fielding of AI technologies. A critical aspect of interaction design for AI-assisted human decision making are policies about the display and sequencing of AI inferences within larger decision-making workflows. We have a poor understanding of the influences of making AI inferences available before versus after human review of a diagnostic task at hand. We explore the effects of providing AI assistance at the start of a diagnostic session in radiology versus after the radiologist has made a provisional decision. We conducted a user study where 19 veterinary radiologists identified radiographic findings present in patients' X-ray images, with the aid of an AI tool. We employed two workflow configurations to analyze (i) anchoring effects, (ii) human-AI team diagnostic performance and agreement, (iii) time spent and confidence in decision making, and (iv) perceived usefulness of the AI. We found that participants who are asked to register provisional responses in advance of reviewing AI inferences are less likely to agree with the AI regardless of whether the advice is accurate and, in instances of disagreement with the AI, are less likely to seek the second opinion of a colleague. These participants also reported the AI advice to be less useful. Surprisingly, requiring provisional decisions on cases in advance of the display of AI inferences did not lengthen the time participants spent on the task. The study provides generalizable and actionable insights for the deployment of clinical AI tools in human-in-the-loop systems and introduces a methodology for studying alternative designs for human-AI collaboration. We make our experimental platform available as open source to facilitate future research on the influence of alternate designs on human-AI workflows.